BACKGROUND: Primary total elbow replacement (TER) services in England are being restructured with the goal of centralising care to specialised centres. It is important to monitor the impact of this service redesign. This protocol outlines an intended analysis to provide detailed descriptions of the patients who are receiving primary TER, where and by whom TER is being performed, and what the current surgical practices for TER are in England before the reconfiguration.
METHODS: This analysis will use the National Joint Registry (NJR) elbow dataset and link it with NHS England Hospital Episode Statistics-Admitted Patient Care (HES-APC). It will include eligible patients from the start of the NJR elbow dataset in April 2012 to December 2022. The main objective is to determine the incidence of TER in England. Age-sex standardised rates will be calculated for groups including different ethnicities, and socioeconomic backgrounds, using the mid-year population data provided by the Office for National Statistics. This planned analysis will summarise patient characteristics such as age, sex, body mass index (BMI), hand dominance, American Society of Anaesthesiologists (ASA) grade, indication for TER, socioeconomic status, and patient co-morbidities. It will also examine implant fixation type, classification, brand/type, and changes over time in implant types used in England. Additionally, it will explore the characteristics and volume of the surgeons and hospitals providing primary TER services, including the grade of the primary surgeons, funding source for surgery, and admission type. The analysis will cover the number of procedures performed by surgeons and hospitals annually in England and in each region of England. Finally, the planned analysis will summarise the elective wait time, postoperative length of stay, and any serious adverse events or re-admissions within 30 and 90 days after the TER.
CONCLUSIONS: This protocol describes the first deep dive analysis into the NJR elbow dataset to describe the incidence of TER surgery in England and the characteristics of patients who are receiving it. This analysis will summarise current primary TER practices in England before service reconfigurations. The impact of reconfiguration can be monitored by comparing future practice to the outcomes from this study. Trial registration ClinicalTrials.gov, NCT06355011. Registered 02 April 2024, https://clinicaltrials.gov/ct2/show/NCT06355011 .

OBJECTIVE: Interposition arthroplasty of the elbow involves the interposition of a fascia lata or dermis autograft or allograft between the distal humerus and the ulna or radius, while preserving the original form of articulation.
METHODS: Interposition arthroplasty is indicated for young patients with high functional demands who suffer from end-stage elbow arthritis and associated pain or joint stiffness.
METHODS: Contraindications include acute or subacute infection, skeletal immaturity, bone loss, deformity, or gross instability.
METHODS: Once the ulnar nerve has been secured, joint access is established via a posterior approach. The radial collateral ligament (RCL) and the common extensor tendon origin (CEO) are detached, while preserving the anconeus muscle and the lateral ulnar collateral ligament (LUCL). Subsequently, a capsular release is required to maintain adequate joint exposure and address the accompanying stiffness. Three to four transosseous drill holes are placed at the level of the distal humerus to secure the graft. After the graft has been positioned successfully within the joint space using two guide sutures, it can be secured to the distal humerus using a horizontal mattress stitch. Finally, the detached tendon and ligament structures are reconstructed.
METHODS: After initial immobilization, early functional exercise of the elbow is performed in the motion orthosis, avoiding valgus or varus stress.
RESULTS: The efficacy of elbow interposition arthroplasty has been demonstrated, particularly for young and active patients with severe inflammatory or post-traumatic osteoarthritis. Despite the results in terms of postoperative function and pain reduction are satisfactory, the current literature reports high complication, subsequent treatment, and revision rates. In the event of interposition arthroplasty failure, revision with another interposition procedure or conversion to endoprosthesis may be considered.
UNASSIGNED: OPERATIONSZIEL: Im Rahmen der Interpositionsarthroplastik des Ellenbogens wird ein Faszien- oder Dermis-Auto- bzw. -Allograft zwischen distalen Humerus und Ulna bzw. Radius interponiert, wobei die ursprüngliche Artikulationsform erhalten bleibt.
UNASSIGNED: Die Indikation zur Interpositionsarthroplastik kann insbesondere bei jungen Patienten mit hohen funktionellen Ansprüchen gestellt werden, die unter endgradiger dysfunktionaler Kubitalarthrose und damit assoziierten Schmerzen bzw. Gelenksteife leiden.
UNASSIGNED: Akute oder subakute Infektionen, grobe Instabilitäten, skelettale Unreife sowie knöcherner Substanzverlust oder Deformitäten gelten als Kontraindikationen.
UNASSIGNED: Über einen posterioren Zugang erfolgt nach Sicherung des N. ulnaris die Etablierung des Gelenkzugangs. Das radiale Kollateralband (RCL) und der gemeinsame Strecksehnenursprung (CEO) werden unter Erhalt des M. anconeus und des lateralen ulnaren Kollateralbandes (LUCL) abgelöst. Um eine ausreichende Gelenkexposition zu erhalten und die begleitende Steife zu adressieren, ist ein anschließendes, aggressives Kapselrelease erforderlich. Zur Fixierung des Transplantats werden 3 bis 4 transossäre Bohrlöcher auf Höhe des distalen Humerus gesetzt. Nach erfolgreicher Positionierung im Gelenkspalt mittels zweier Führungsfäden kann das Transplantat mit horizontalen Matratzennähten am distalen Humerus befestigt werden. Abschließend erfolgt die Rekonstruktion der abgelösten Sehnen- bzw. Bandstrukturen.
UNASSIGNED: Nach initialer Ruhigstellung erfolgt eine frühfunktionelle Beübung des Ellenbogens in der Bewegungsorthese unter Vermeidung von Valgus- bzw. Varusstress.
UNASSIGNED: Die Interpositionsarthroplastik stellt ein „Salvage-Procedure“ für junge und aktive Patienten mit schwerer inflammatorischer oder posttraumatischer Arthrose des Ellenbogens dar. Trotz zufriedenstellender Ergebnisse hinsichtlich postoperativer Funktion und Schmerzreduktion berichtet die aktuelle Literatur über hohe Komplikations‑, Nachbehandlungs- und Revisionsraten. Bei Versagen der Interpositionsarthroplastik ist eine Revision mittels eines weiteren Interpositionsverfahrens oder eine Konversion zur Endoprothese möglich.

OBJECTIVE: The aim of the operation is to replace the articular surface of the distal humerus in cases of nonreconstructible fractures of the distal humerus.
METHODS: Active patients with high functional requirements, in whom weight limitation of total elbow arthroplasty should be avoided.
METHODS: Contraindications include fractures with irreconstructible epicondyles and/or irreconstructible collateral ligaments, as well as ulnohumeral, or radiohumeral osteoarthritis.
METHODS: Following subcutaneous anterior transposition of the ulnar nerve, surgical dislocation of the elbow joint is achieved through a paratricipital approach with release of the soft tissue structures from the humerus. After resection of the trochlea, the intramedullary canal of the humerus is prepared using rasps in order to implant the hemiprosthesis with retrograde cementing. Finally, the medial and lateral collateral ligaments as well as the flexors and extensors are repaired.
METHODS: Early functional rehabilitation in a hinged elbow orthosis while avoiding varus/valgus stress after wound healing is completed.
RESULTS: Between 2018 and 2022, 18 patients with coronal shear fractures were treated with elbow hemiarthroplasty. The mean Mayo Elbow Performance Score (MEPS) was 79 (70-95) after a mean follow-up of 12 months. The mean range of motion was 99° (70-130°) in extension-flexion and 162° (90-180°) in pronation-supination.
UNASSIGNED: OPERATIONSZIEL: Ziel der Operation ist der Ersatz der Gelenkfläche des distalen Humerus bei nicht rekonstruierbaren Frakturen des distalen Humerus.
UNASSIGNED: Aktive Patienten mit hohem funktionellem Anspruch, bei denen eine Gewichtslimitierung aufgrund einer Ellenbogentotalendoprothese vermieden werden soll.
UNASSIGNED: Kontraindikationen bestehen bei Frakturen mit nicht rekonstruierbaren Epikondylen und/oder nicht rekonstruierbaren Kollateralbändern sowie bei ulnohumeraler oder radiohumeraler Arthrose.
UNASSIGNED: Über einen paratrizipitalen Zugang erfolgt nach subkutaner, anteriorer Transposition des N. ulnaris die chirurgische Luxation des Gelenks durch humerales Ablösen der Weichteilstrukturen. Anschließend wird die Trochlea reseziert und der Humerus mittels Raspeln eröffnet, sodass anschließend die Hemiprothese unter retrograder Zementierung implantiert werden kann. Abschließend erfolgt die Rekonstruktion des medialen und lateralen Kollateralbandapparats sowie der Flexoren und Extensoren.
UNASSIGNED: Frühfunktionelle Beübung des Ellenbogens in der Bewegungsorthese unter Vermeidung von Varus‑/Valgusstress nach Abschluss der Wundheilung.
UNASSIGNED: Zwischen 2018 und 2022 wurden 18 Patienten mit koronaren Abscherfrakturen mit einer Hemiprothese versorgt. Der durchschnittliche Mayo Elbow Performance Score (MEPS) lag nach einem mittleren Nachverfolgungszeitraum von 12 Monaten bei 79 Punkten (70–95). Der durchschnittliche Bewegungsumfang betrug in Extension-Flexion 99° (70–130°), in Pronation-Supination 162° (90–180°).

OBJECTIVE: Searching for quick determinable biomarkers with high sensitivity and specificity is necessary to improve and optimise the early diagnosis of periprosthetic elbow infection (PEI). Therefore, this study\'s objective was to evaluate the diagnostic value of synovial fluid interleukin-6 (IL-6) levels for diagnosing PEI in total elbow arthroplasty.
METHODS: Twelve prospective enrolled patients underwent total elbow arthroplasty revision surgery, during which synovial fluid was obtained. Between the initial implantation and the revision procedure were 33.5 ± 41 months (range, 2-144 months). Synovial fluid was collected for immediate IL-6 analysis parallel to the revision surgery. Furthermore, microbiological samples were obtained and analysed. Two groups were defined based on the microbiological results: non-infection and infection group. The ability of synovial fluid IL-6 analysis to predict infection status was explored using receiver operating characteristic curves and further statistical analysis.
RESULTS: Synovial fluid IL-6 analysis had a good diagnostic accuracy of 83% for PEI with an area under the curve of 0,79 and an ideal cutoff value (determined using Youden\'s criterion) of 15244 pg/mL.
CONCLUSIONS: This is the first study to clinically evaluate IL-6 as a diagnostical marker for periprosthetic joint infection (PJI) in total elbow arthroplasty. Our results suggest a good accuracy and high sensitivity for IL-6 to identify a PEI. The analysis of IL-6 can improve surgical decision-making regarding managing total elbow arthroplasty in terms of one- or two-staged revision.
CONCLUSIONS: IL-6 can play an important role in the perioperative differentiation of infected and non-infected situations.

BACKGROUND: This study aimed to evaluate the influence of training background on the frequency and indications of elbow arthroplasty performed by early-career surgeons.
METHODS: A review of the American Board of Orthopaedic Surgery Part II Oral Examination Case List database from 2010 to 2021 was completed. The number of cases performed by surgeons from each individual training background were calculated and compared with the total number of surgeons who completed each fellowship during the study period.
RESULTS: Hand surgeons performed the most elbow arthroplasty cases (132, 44%), but a higher percentage of shoulder/elbow surgeons performed elbow arthroplasty in comparison (15% vs. 7%). The mean number of TEA cases performed by shoulder/elbow surgeons was significantly higher than in other subspecialties (P < 0.01). However, when comparing only surgeons who performed elbow arthroplasty during the board collection period, there was no significant difference between training backgrounds (P = 0.20).
CONCLUSIONS: While hand surgeons performed the most elbow arthroplasty cases, a higher percentage of shoulder/elbow surgeons performed elbow arthroplasty during the study period. The high prevalence of distal humerus fracture as an indication for arthroplasty reflected a shift in indications and was not related to training background.

BACKGROUND: The primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures with those of secondary total elbow arthroplasty after failed internal fixation. The secondary objective was to compare the complication rates and the radiographic results in the 2 groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed after failed internal fixation were comparable to those of primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population.
METHODS: We conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85 years), who either underwent a primary total elbow arthroplasty (group 1; 45 patients) or secondary total elbow arthroplasty after failed internal fixation (group 2; 15 patients) in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including the Mayo Elbow Performance Score and triceps proficiency test, complication rates, and the need for reoperation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120 months).
RESULTS: The clinical results of the 2 groups were comparable when looking at the Mayo Elbow Performance Score (90.00 [85.00, 100.00], P = .486). With regard to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (P = .099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (P = .448), and 1 patient with triceps insufficiency in group 1.
CONCLUSIONS: Secondary total elbow arthroplasty after failed internal fixation has shown good functional results and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.

BACKGROUND: We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of stress shielding (SS) after a MoPyC radial head arthroplasty.
METHODS: We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ± 14.90 (range, 25.00-91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ± 2.8 (range, 0.5-11).
RESULTS: SS was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ± 0.09, 1.05 ± 0.18, and 0.79 ± 0.11, respectively. The presence of SS was significantly associated with MD:CW (adjusted odds ratio = 13.66; P = .001), and expansion of the stem (adjusted odds ratio = 3.78; P = .001). The amount of the SS was significantly correlated with expansion of the stem (aβ 4.58; P < .001).
CONCLUSIONS: Our study found that MD:CW was an independent risk factor of SS after MoPyc radial head arthroplasty. Autoexpansion of the MoPyc stem significantly increased the risk of SS and its extent. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study.

BACKGROUND: Total elbow arthroplasty (TEA) is an appropriate surgical treatment option for a variety of conditions ranging from inflammatory arthritis to trauma. Because of a high complication profile, implant companies have attempted to improve patient outcomes with evolving design mechanics and philosophy. However, the Nexel TEA prosthesis has been criticized for its unacceptably high revision rate by other research groups in the literature. The purpose of this study was to evaluate the survivorship and revision rates of the Nexel and Coonrad-Morrey TEA implant systems in New Zealand.
METHODS: Prospectively collected National Joint Registry data were used to compare the survival rates of these prostheses. Underlying diagnoses, reasons for revision, and patient demographics were all recorded. Statistical analysis included survival analysis using Kaplan-Meier curves and comparison between groups using independent t tests.
RESULTS: Over the 23-year study interval, the Nexel and Coonrad-Morrey prostheses showed similar survivorship and revision rates. The revision rates at 5 years were 7.3% for Nexel and 4.5% for the Coonrad-Morrey cohorts. The average time to revision for those who are revised was 3.13 ± 1.74 years in the Nexel group and 4.93 ± 4.13 years in the Coonrad-Morrey population.
CONCLUSIONS: Our study confirms a lower revision rate of the Nexel TEA compared to other studies in the literature. Additionally, the Nexel TEA implant performs comparably to its predecessor, the Coonrad-Morrey prosthesis in New Zealand. Although it is difficult to explain the discrepancy in results with the study by Morrey et al, future studies should focus on investigating postoperative radiographs and a deep analysis of the specific surgical technique used for this implant.

BACKGROUND: Revision of tumor-type prosthetic fractures is very challenging in clinical work. Traditional repair methods may not be able to meet the needs of complex cases or cause greater bone damage. Therefore, more effective and reliable solutions need to be found.
METHODS: This study presents a novel revision technique for managing fractures of tumor-type total elbow prostheses. A 57-year-old female patient was diagnosed with a left distal humeral bone tumor accompanied by pathological fracture and underwent customized tumor-type total elbow prosthesis arthroplasty. After 5 years, she experienced pain and encountered difficulty in flexing the left elbow while lifting heavy objects. The X-ray examination revealed a fracture of the distal humeral prosthesis. As a response, the elbow joint was initially explored, and the damaged component of the prosthesis was extracted. Subsequently, we utilized 3D printing technology to design a split-piece sleeve prosthesis and effectively restored the fractured left distal humerus implant. During the 2-year follow-up, The X-ray demonstrated satisfactory positioning of the prosthesis, which remained securely affixed without any indications of loosening. The Mayo Elbow Performance Score (MEPS) reached 80 points, the Musculoskeletal Tumor Society (MSTS) attained a score of 28 points, and the range of motion of the elbow was measured between 25° and 110°, revealing favorable functional outcomes.
CONCLUSIONS: The utilization of a 3D printed split-piece sleeve prosthesis presents a viable clinical treatment strategy for addressing fractures in tumor-type elbow prostheses.

BACKGROUND: The incidence of radial head fractures is increasing, and radial head arthroplasty (RHA) is being more frequently used as treatment for irreparable fractures. Our objective was to compare radiocapitellar pressure between the native joint and 2 radial head prosthesis conditions: (1) a prosthetic head that was aligned to the forearm axis of rotation and (2) the same prosthesis with an axisymmetric nonaligned head.
METHODS: Ten cadaveric specimens received a pressfit radial head prosthesis (Align; Skeletal Dynamics) for both prosthetic testing conditions. Anatomic alignment (AL) was defined as the prosthetic head aligned to the forearm axis of rotation. Axisymmetric alignment (AX) was defined as the prosthetic radial head aligned to the axis of the prosthetic stem. Axial load was applied with the elbow in extension and the forearm pronated. Data were collected using a Tekscan 4000 sensor.
RESULTS: The mean pressure in the AL and AX groups were significantly higher than the mean pressure in the native joint. Compared with the native joint, the mean pressure was 19% higher in the AL group and 56% higher in the AX group. Peak pressure beyond 5 MPa occurred in 0 specimens in the native joint group, in 1 specimen (10%) in the AL group, and in 5 specimens (50%) in the AX group.
CONCLUSIONS: Our results demonstrated that a pressfit radial head prosthesis aligned with the forearm axis of rotation yields capitellar pressures that were more similar to the native condition than a nonaligned pressfit prosthesis. These findings suggest that anatomic alignment may optimize capitellar wear properties, improving the long-term durability of radial head arthroplasty.